University of the Sacred Heart

To investigate the morphological and dimensional changes in vacuum-formed retainers (VFRs) after intraoral aging of 3 months and 6 months and to compare changes between VFRs with conventional and modified gingival margin design. Forty-one patients were randomly assigned to two groups: conventional design (CD) and modified design (MD). Preuse and postuse digital models of each VFR were imported to Geomagic Control software to assess the morphological and dimensional changes. In vivo, VFRs underwent significant changes over time. After 3 months, slight expansion of the VFRs was detected, while after 6 months, slight contraction was observed, despite not all parameters resulting in statistically significant differences. No statistically significant differences were found between the CD and MD groups. Intraoral aging affects the dimensional stability of VFRs. The gingival margin design did not impact the morphological and dimensional stability of VFRs over the observed period.

Polyhydramnios is usually diagnosed with an amniotic fluid index (AFI) ≥ 24.0 cm or a maximum vertical pocket (MVP) ≥ 8.0 cm [1]. However, which methodology—AFI versus MVP—has a stronger association with adverse perinatal outcomes is uncertain. Our aim was to undertake a systematic review of the literature of studies comparing AFI, MVP or AFI&MVP for polyhydramnios related to adverse perinatal outcomes. We conducted a systematic review of the literature. Medline, Cochrane Library, EMBASE, Pubmed Central, Scopus and ClinicalTrial.gov were electronically searched from their inception to April 2025. Multiple combinations of (MeSH) terms and word variants (‘amniotic fluid index’, ‘AFI’, ‘deepest vertical pocket’, ‘DVP’, ‘maximum vertical pocket’, ‘MVP’, ‘polyhydramnios’, ‘hydramnios’) were used. No restrictions for geographic location or temporal limit were applied. Evaluation of each included study followed the Newcastle Ottawa Scale for cohort studies [2]. Disagreements were resolved by discussion until a consensus was reached. As we originally planned to do a systematic review and meta-analysis, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration No. CRD420251040958). Studies were included if they evaluated adverse perinatal outcomes by either AFI, MVP or AFI and MVP for the diagnosis of polyhydramnios. Electronic search, inclusion criteria and risk of bias assessment were independently assessed by two reviewers (AP and VB). Data from each eligible study were extracted without modification of original data onto custom-made data collection forms. The primary outcome was perinatal mortality, as defined by the included studies [3] (sum of stillbirths and neonatal deaths). Secondary outcomes were large for gestational age (LGA) or macrosomia (estimate of fetal weight ≥ 90th percentile or absolute weight ≥ 4000 g, respectively), fetal growth restriction (FGR, estimate of fetal weight < 10th percentile or as defined by included studies), IUFD, neonatal intensive care unit (NICU) admission and neonatal death. Out of 133 studies screened, there were no RCTs comparing the outcomes using MVP, AFI or both. Five non-RCT studies were assessed for eligibility for a total of 5319 patients [3-7] (Figure 1). However, only one retrospective study reported neonatal outcomes [7] (Table 1) and could be included in the analysis, and it was judged as low quality. In this study, polyhydramnios was identified by an AFI ≥ 24 cm or an MVP ≥ 8 cm on at least one ultrasound ≥ 20 weeks [7]. Those diagnosed with polyhydramnios by both methods had an increased risk of perinatal mortality (aRR = 5.94, 95% CI 3.07–11.50), including IUFD (aRR = 5.58, 95% CI 2.81–11.09) and neonatal death (aRR = 13.07, 95% CI 1.72–99.60), compared to those with normal amniotic fluid (Table 1). Only MVP and AFI were associated with increased risks of FGR, IUFD, NICU admission, neonatal and perinatal death (Table 1). Although polyhydramnios is frequently found in clinical practice, there is limited prospective, high-quality data concerning the best ultrasonographic methodology associated with adverse perinatal outcomes. Only Kraus et al. [7] compare AFI, MVP or both in terms of adverse perinatal outcomes, finding that polyhydramnios diagnosed by both methods is associated with an increased risk of perinatal mortality (Table 1). This is interestingly in contrast with the literature regarding oligohydramnios. A recent meta-analysis included 6 RCTs for a total of 4278 patients in the setting of oligohydramnios [4] showed that the use of MVP was associated with significantly lower rates of non-reassuring fetal heart tracing, Caesarean Delivery for non-reassuring fetal heart testing, and induction of labour, but without any worsening of adverse pregnancy outcomes [4]. To our knowledge, there are no ongoing RCTs on polyhydramnios diagnosis in terms of adverse perinatal outcomes. There is an urgent need for RCTs comparing different ultrasonographic methodologies for the diagnosis of polyhydramnios in terms of adverse perinatal outcomes, leading to an evidence-based management of polyhydramnios in everyday clinical practice. All authors fulfil the criteria of authorship. The authors have nothing to report. Transparency: The lead author (the manuscript's guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Mentalising skills may be conceptualised as composed by both personal and interpersonal competencies, in turn shaped by early adverse experiences and coping strategies. Although cross-sectional observations described a role for mentalising skills in burnout development, large-scale longitudinal studies on the topic remain limited, especially in relation to psychiatry training. The primary aim was to investigate protective and risk factors for higher burnout scores across time. Secondary aims included testing whether psychiatry exhibited different burnout scores across time in comparison to other medical residents. A cohort of 1803 medical residents (1131 psychiatry residents) was assessed for mentalising skills, conceptualised as composed of emotional regulation (Difficulties in Emotion Regulation Scale), interpersonal competencies (Interpersonal Competence Questionnaire), coping strategies (Coping Orientation to Problems Experienced) and burnout dimensions (Maslach Burnout Inventory). One-year follow-up was available for 520 psychiatry residents (73.03% response rate) and 234 other medical residents (35.94% response rate). Longitudinal mixed models and bivariate latent change models were employed. Across all residents, greater levels of burnout were associated with higher scores in insecure attachment, emotional dysregulation and maladaptive coping, as well as lower scores in interpersonal skills. Attending at least one supervision per month was associated with lower burnout scores across time. According to a bivariate latent change model, emotional regulation improvements through years were associated with lower burnout scores across time. In psychiatry residents, lower burnout scores across time were observed as compared to other medical residents. Psychiatry residents benefited from a higher protective effect of interpersonal competencies (group by moderator by time interaction) and coping strategies against burnout. Mentalising skills may mitigate burnout development. Training in psychiatry emerged as a potential mitigating factor against burnout increases. Structured supervisions may foster professional development and emotional resilience.

Background: Euthyroid Sick Syndrome (ESS) is a clinical condition characterized by reduced free triiodothyronine (FT3) levels in response to acute or chronic stress. Proximal femur fractures in geriatric patients are associated with high morbidity and mortality rates and ESS may influence outcomes in this population. This study aimed to investigate the role of ESS as a predictor of complications in elderly patients with hip fractures, analyzing its association with inflammatory and nutritional markers, including the Monocyte-to-Lymphocyte Ratio (MLR), Controlling Nutritional Status (CONUT) score and Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score. Materials and Methods: We conducted a single-center retrospective analysis of patients aged 65 and older who were admitted with proximal femur fractures requiring surgical intervention. Thyroid hormone profiles, inflammatory markers and other clinical variables were analyzed preoperatively (T0) and on the first (T1) and third (T2) postoperative days. Logistic regression was used to identify predictors of complications and transfusion requirements. Results: The study included 103 patients (72 men, 31 women; mean age 85 ± 6.27 years). ESS was present in 30 patients (29%) and was associated with longer surgery duration (83.9 ± 35.5 vs. 68.9 ± 21.3 min; p = 0.042). At admission (T0), ESS patients had lower FT3 (1.91 ± 0.25 vs. 2.75 ± 0.28 pmol/L; p < 0.001) and higher TSH (1.55 ± 0.75 vs. 1.20 ± 0.80 mIU/L; p = 0.057). Postoperatively, MLR was significantly altered at T1 (p = 0.026) and T2 (p = 0.040). ESS was a significant predictor of complications at T0 but lost significance postoperatively, while MLR emerged as a key predictor at T2 (p = 0.003). Logistic regression confirmed MLR at T2 as an independent predictor of complications. Hemoglobin levels at T0 (p < 0.001), T1 (p < 0.001), and T2 (p < 0.001), along with albumin at T1 (2.67 ± 0.34 vs. 2.94 ± 0.33 g/dL; p = 0.001) and calcium at T1 (p = 0.006), were significant predictors of transfusion requirements. Nutritional and inflammatory scores were not predictive. Conclusions: ESS is a significant initial predictor of complications in geriatric patients with hip fractures, but inflammatory markers such as MLR assume greater relevance in the postoperative period. These findings emphasize the importance of monitoring ESS and MLR to enhance risk stratification and guide personalized management strategies.

Purpose This study aims to examine the relationship between family firm internationalization and short-term accounting performance (return on assets (ROA)) and long-term market-based performance (average market value (AMV)), considering the unique context of socioemotional wealth (SEW) preservation. Design/methodology/approach Utilizing a sample of 641 observations pertaining to Italian and German family-owned firms, we empirically test two hypotheses with regression analysis: (1) a positive linear impact of internationalization on ROA and (2) a U-shaped curvilinear impact on AMV. Findings Our results confirm a positive linear relationship between family firm internationalization and short-term ROA, indicating immediate financial benefits from initial global engagement. Furthermore, we find support for a U-shaped curvilinear relationship between internationalization and AMV. This suggests that while early internationalization may initially temper market valuation, deeper and more extensive international engagement ultimately can contribute to enhancing long-term value. Practical implications Family business managers should recognize that even modest internationalization can yield short-term financial gains. For long-term value creation, a sustained and strategic approach to internationalization is crucial, requiring patience through initial market reactions. Policymakers can support family firms in navigating these complex internationalization trajectories. Originality/value Overall, our analysis enriches the family business and international business literature by offering a dual-perspective analysis of internationalization's impact on financial performance. It provides a more granular understanding of how family firms reconcile SEW preservation with global expansion, moving beyond a simple trade-off to a dynamic process of value creation.

Abstract BRAF mutations are oncogenic drivers present in about 7% of human cancers, with the V600E substitution being the most frequent. In the nervous system, BRAFV600E has been identified in both low- and high-grade gliomas (LGG and HGG) and in tumors of the peripheral nervous system. To investigate the mechanisms underlying BRafV600E-driven tumorigenesis, we generated a mouse model in which the BRafV600E mutation and Pten deletion can be induced through the Sox2-CreERT2 system. This inducible deleter is active in adult neural stem/progenitor cells (aNSPCs) and Schwann cell precursors (SCPs). In this model, BRafV600E-mutated/Pten-deleted telencephalic aNSPCs give rise to diffuse LGG with oligodendroglioma-like features resembling the human diffuse LGG, MAPK pathway–altered subtype. In contrast, mutated SCPs develop schwannomas, cutaneous neurofibromas, and malignant peripheral nerve sheath tumors (MPNSTs). Sox2 deletion in BRafV600E/Ptendel mice markedly reduces tumor formation, indicating that aNSPCs act as tumor cells of origin. In vitro analyses show increased proliferation of BRafV600E/Ptendel aNSPCs and preferential differentiation toward oligodendroglia-like tumor cells. BRaf-mutant aNSPCs display increased Sox2 protein, but not mRNA levels, suggesting post-transcriptional regulation. Sox2 phosphorylation at T118 is promoted by BRafV600E, potentially stabilizing the protein during aNSPC transformation, although the involvement of downstream kinases cannot be excluded.

Changes in lung and pleural pressures during mechanical ventilation are transmitted to intrathoracic structures, including the venous system. As a result, respiratory swings in central venous pressure (CVP) may reflect variations in pleural pressure, typically estimated using esophageal pressure (Pes). However, the point on the CVP waveform used for measurement may influence this relationship. Our aim is to find the best association between ∆Pes and each ∆CVP considering different points in the CVP waveform to calculate ∆CVP. In this prospective study, we analysed CVP and Pes waveforms in 22 mechanically ventilated patients. For each cardiac cycle, three CVP values were identified: the minimum (CVPmin), the maximum (CVPmax), and the average (CVPavg). From these, four types of respiratory CVP variation (∆CVP) were calculated per breath: ∆CVPmin = max-min of CVPmin values; ∆CVPmax = max-min of CVPmax values; ∆CVPavg = max-min of CVPavg values; ∆CVPtot = absolute difference between the highest CVPmax and the lowest CVPmin within each respiratory cycle. The primary objective was to assess the association between ∆Pes and each ∆CVP variant using linear mixed-effects models. A total of 2,286 breaths (median 104 per patient) was analysed. All ∆CVP measures showed a statistically significant association with ∆Pes. The strongest correlation was observed for ∆CVPtot, with a marginal R² of 0.50 and a conditional R² of 0.78. The association further improved when using the median of multiple consecutive breaths. Specifically, the marginal R² increased from 0.60 (median of 3 breaths) to 0.70 (median of 23 breaths). Among the different measurement strategies, ∆CVPtot—defined as the difference between the highest and lowest CVP values within a respiratory cycle—showed the strongest association with ∆Pes. Averaging over at least three consecutive breaths further enhanced this relationship. These data are useful for understanding how ∆CVP can be used to estimate ∆Pes at the bedside.

Converging evidence suggests that infants can extract and integrate emotional content from multiple sources (e.g., faces, body postures, and voices). Yet this evidence is mostly based on static representations of emotions, such as photographs, whereas in everyday life, infants are primarily exposed to dynamic input, particularly others' actions. This study investigates whether infants can link emotional information conveyed in action kinematics and facial expressions. To address this issue, we used an ERP priming paradigm in which 12-month-olds were presented with video primes of actions performed with happy or angry kinematics, followed by target images of faces displaying happy or angry facial expressions. Results revealed a P400 congruency effect over the right hemisphere. Specifically, happy faces elicited a larger P400 than angry faces when they followed an incongruent emotional action. Moreover, the P400 was larger for incongruent than for congruent happy facial expressions. Results suggest that bodily kinematics provide infants with crucial contextual and emotional cues that bias their perception of facial expressions from early in life.

Spontaneous subarachnoid hemorrhage (sSAH) is a critical neurological condition with high mortality and significant long-term sequelae. Delayed cerebral ischemia (DCI) is a significant contributor to poor clinical outcomes. Despite advances in management, early predictors of clinical outcomes and DCI remain unclear. This study investigates whether serum ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), a neuronal injury biomarker, can predict functional outcomes, mortality, and DCI in patients with sSAH. A prospective observational study was conducted from January 2022 to June 2024, enrolling adults (≥18 years) with sSAH confirmed by neuroimaging on admission. Blood samples were collected at 24 hours (T0), 72 hours (T1), and 7 days (T2) after sSAH onset. UCH-L1 levels were measured using an automated analyzer. Outcomes were functional status, assessed by the modified Rankin Scale at 14 days and 3 months, mortality, the occurrence of DCI, and determination of UCH-L1 cutoff values predictive of poor prognosis. A total of 102 patients with sSAH were included. UCH-L1 levels measured 24 hours after admission were independent predictors of poor outcomes ( P < .001) and DCI ( P = .026). The optimal UCH-L1 cutoff for predicting poor outcomes at 14 days and 3 months was 174.6 pg/mL (odds ratio 10.55, 95% CI 4.23-26.36 and odds ratio 7.79, 95% CI 3.11-19.52, respectively). Early serum UCH-L1 levels are significant predictors of clinical outcomes, mortality, and DCI in patients with sSAH, suggesting that UCH-L1 could be a promising biomarker for guiding early prophylactic and therapeutic interventions in the management of sSAH.

Abstract Introduction : Artificial intelligence(AI) techniques may combine various omics datasets to create more accurate predictive models for lung cancer patients management. The aim of this study from the LANTERN project, is to develop an AI-based predictive model of post-operative complications after lung resection for NSCLC. Methods In the framework of LANTERN Consortium we prospectively collected data from 3/2023 to 12/2024 of patients who underwent curative surgery for Stage I-III NSCLC and were herein analyzed considering 80 preoperative clinical features and 43 spirometric variables to predict the occurrence of post-operative complications. Prediction models were developed on the basis of different feature selection algorithms and machine-learning models. An external dataset composed by a surgical series of 232 patients was used for validation. Results The final analysis was conducted on 231 surgical patients. Post-operative complications were observed in 37 patients (16%). AI-based models showed that pathologic score (AUC = 0.72, 95% CI [0.62–0.81]) and pre-opFEV1_TEOR (AUC = 0.77, CI [0.67–0.89]) was the most relevant variables. Testing the models on the external dataset, while the predictive value of Pathologic score alone was reduced, pre-opFEV1_TEOR and the combination of Pathologic score and pre-opFEV1_TEOR were confirmed to predict post-op outcome. Postoperative risk rises by about 6% per pathologic score level and 11–12% for each 10% decrease in FEV1_TEOR. Conclusions Combining the FEV1_TEOR and the pathologic score permits to predict the complications risk in significant way. This model could be tested in a further prospective cohort of patients to verify its effectiveness in order to improve the perioperative management of lung resection candidates.